PS08 Skin lightening product use among British Indian immigrants: a qualitative study exploring causes and consequences
Authors: Divya Khanna, Gilles de Wildt, Antje Lindenmeyer
Journal: British Journal of Dermatology (2023)

Abstract Cosmetic, topical skin-lightening products (SLPs) containing steroids, hydroquinone and mercury are available to Indian consumers without dermatological supervision. The World Health Organization discourages such SLP use, recognizing scar tissue formation, skin atrophy, localized infection, chemical burn and renal/hepatic impairment as adverse effects. Despite legislation restricting the sale of unlicensed SLPs in the UK, they remain accessible to British Indians through illegal importation. The current literature focuses on the high prevalence of unsupervised SLP use in India, documenting its psychodermatological and physical harm. However, no research has explored the causes and consequences of its use among British Indian communities, despite notable variances in culture. This qualitative study addresses the research gap to inform future management of unsafe SLP use. After ethical approval was granted, 24 semi-structured, in-depth interviews were conducted. Participants were recruited using maximum variation and snowball sampling through national radio and social media advertising, to encourage generalizability. Transcripts and field notes were analysed using conventional thematic and deviant case analysis, using NVivo 12 software. Two interdependent sets of themes influencing SLP use emerged. The first set, titled ‘Causes of SLP use’, included the following themes: ‘British cultural influence’, ‘product accessibility’ and ‘Indian beauty standards’. The second set, titled ‘Consequences of SLP use’, included the following themes: ‘financial’, ‘social’, ‘intrapersonal’, ‘physical’, ‘societal’ and ‘psychological’. Participants felt the Indian beauty standard derives from caste, religion, colonialism, Ayurvedic medicine and Indian media, which together heavily depict fair skin as superior, encouraging SLP use. This was further facilitated by frequent advertising on Indian television channels and social media, and the abundance and affordability of SLPs in South Asian stores in the UK. Participants persistently used SLPs, despite experiencing burning and patchy dyspigmentation as common adverse effects. Open internalized racism within the community instilled shame and stigma against those with darker skin, encouraging SLP use. Participants believed this was less common among second- and third-generation British Indians, discouraging SLP use, due to increased assimilation into British culture and improved media representation of people of colour. Participants agreed that SLP use negatively impacts on personal identity but identified its potential to elevate social desirability. This study newly highlights the significant negative psychodermatological impact of unsupervised SLP use among the British Indian community. As a factor propagating internalized racism, this study identifies a need to control illegal SLP importation and provide community-wide education on unsafe SLP use. These management strategies should be evaluated in future research.